Maternity Benefit – Included On All ACA Plans
Before the ACA, most employer-sponsored health plans included maternity coverage, but the majority of individual market plans did not. While the ACA greatly increased the number of plans covering maternity care – by requiring all individual and small group plans to cover maternity care as an EHB – gaps in maternity coverage still persist. Women covered under grandfathered and transitional health plans, as a dependent on a parent’s employer-sponsored plan, or on self-funded student health plans still may not have maternity coverage.
Maternity coverage is an essential benefit available on all ACA Blue Cross and Blue Shield of Illinois plans except for grandfathered plans such as the BlueEdge HSA plans.
Blue Cross and Blue Shield of Illinois provides a superior maternity benefit for individuals and families. If you’re an Illinois resident who needs maternity coverage, but you’re not covered under an employer-sponsored plan, Blue Cross and Blue Shield of Illinois is about as good as it gets.
Pregnancy Complications
Blue Cross and Blue Shield of Illinois health insurance plans for individuals and families automatically include benefits for complications of pregnancy. This is a standard plan provision. The optional maternity coverage benefit applies only to routine pregnancy expenses.
Yes, Epidurals are covered but must be pre-authorized by the plan.
Is anything covered for a homebirth with a midwife? Or are there any midwife practices that you will work with?
Hi Sydney — most BCBS IL plans cover Certified Nurse Midwife (CNM) services in a hospital or accredited birth center, but planned homebirths are generally not a covered benefit, and Licensed CPMs (the most common homebirth credential in Illinois) are not in BCBS IL’s network. A few PPO plans may apply out-of-network benefits if the attending provider is a credentialed CNM, but reimbursement is rarely full and pre-authorization is almost always required. Best to call the Member Services number on the back of your card to confirm your specific plan, or email us at info@ilhealthagents.com with your plan name and we’ll review your benefits with you.